The present population-based study proposes to continue the examination of trends in the incidence, in-hospital, and long-term survival rates of acute myocardial infarction (AMI) and out-of hospital deaths due to coronary heart disease (CHD) in residents of the Worcester, MA, Standard Metropolitan Statistical Area (SMSA). The objectives of this observational study are to examine recent (2005 and 2007), as compared to prior (1975-2003), trends in the annual attack rates of AMI, hospital and post-discharge survival rates, management practices, and out-of-hospital deaths attributed to CHD. To accomplish these and several additional secondary objectives, the proposed study will be carried out in the 11 acute care general hospitals in the Worcester, MA, SMSA (2000 census count=478,000). This study will utilize and extend previous approaches used in the conduct of this longitudinal study. All new (incident) and recurrent episodes of definite AMI occurring among Worcester SMSA residents during calendar years 2005 and 2007 will be identified from discharge diagnostic printouts obtained from all metropolitan Worcester hospitals. The medical records of greater Worcester residents will be individually reviewed for validation purposes according to pre-established diagnostic criteria for AMI. Abstraction of the medical records of patients satisfying the diagnostic and geographic eligibility criteria will be carried out with the standardized recording of relevant data. A review of records for additional hospitalizations and a search of death certificates will be carried out to examine the long-term survival status of discharged hospital patients from each of the proposed study years, as well as those identified previously (1975-2003), through 2008. Death certificates will be reviewed to identify cases of out-of-hospital deaths due to CHD occurring in 2005 and 2007 to determine changes over time in these death rates. The results of this community-wide investigation will provide important insights from a 32 year (1975-2007) vantage point about the magnitude of, mortality from, and treatment approaches used in the management of the nation's leading cause of death as it affects residents of a large Northeast metropolitan area. [unreadable] [unreadable]